Single-stage transverse process resection, debridement, interbody fusion, and internal fixation for the treatment of lumbar spinal tuberculosis via posterior-only approach

Abstract Background: Spinal tuberculosis (TB) is a less frequently reported infectious spinal pathology. There are controversies on the surgical intervention of lumbar spinal TB with neurological damage and paraspinal abscess. This retrospective study was conducted to determine the effectiveness of single-stage transverse process resection, debridement, interbody fusion, and internal fixation for the treatment of lumbar spinal TB via posterior-only approach.Methods: From January 2015 to June 2018, 32 consecutive patients (19 males and 13 females) with lumber spinal TB complicated with neurological damage and paraspinal abscess treated by single-stage transverse process resection, debridement, interbody fusion, and internal fixation were enrolled. Medical records, imaging studies, laboratory data were collected and summarized. Anti-TB drugs with HREZ chemotherapy regimen was administered to all patients. Surgical outcomes were evaluated based on visual analogue scale (VAS), American Spinal injury Association (ASIA) classification. The changes in C-reactive protein (CRP) levels, erythrocyte sedimentation rate (ESR), clinical symptoms and complications were investigated. Graft fusion was evaluated using Bridwell grading criteria.Results: The mean follow-up period was 20.41 ± 5.19 months. No implant failures were observed in any patients. Wound infection was observed in one patient. Solid bony fusion was achieved in 9 cases at 6 months and 23 cases at 12 months after operation. Kyphosis angle was 11.28 ± 4.01° at final follow-up. The levels of ESR and CRP were returned to normal at the final follow-up. VAS scores were significantly improved (P < 0.05). According to ASIA classification, 6 cases were classified as with grade D and 26 cases were classified as grade E at the last follow-up.Conclusion: Single-stage transverse process resection, debridement, interbody fusion, and internal fixation via posterior-only approach is a feasible and effective surgical therapy for lumbar spinal TB with neurological damage and paraspinal abscess.